EP 35 The Paradigm Shift of Active Shooter Response

Erik Franco on the Paradigm Shift of Active Shooter Response from HSTM

EP 35 The Paradigm Shift of Active Shooter Response

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[TODD DEVOE] Hi, this is Todd DeVoe with EM Weekly, and today we have Erik Franco on with High-Speed Tac Med (HSTM). And we’re gonna have a couple of conversations here regarding first response mode to an active shooter, and this has really been something that we’ve been focusing on here lately, with the news with Vegas and now Texas. I think it’s appropriate to have this conversation. So, Erik, welcome to EM Weekly.

[ERIK FRANCO] Thank you very much. I appreciate it, Todd.

[TODD DEVOE] So Erik, how did you get started in the world of the High-Speed Tac Med and disaster medicine in general?

[ERIK FRANCO] Well, a little bit about my background, which kind of led up to active shooter training and Tac Med training. For the past about 14 years, I’ve actually been involved as a reserve deputy and search and rescue for a large sheriff’s department. And one of the things that we do, as far as our search and rescue team responds to anything. An active shooter situation, barricade, suspect situations, suspects that run up into the mountains, or that just go into an area and you need additional bodies on our team. We’ve got about 30 people that can respond 24 hours a day and 7 days a week, nonstop, every single day, out of the year. And that’s been kind of built into exactly our response. But it wasn’t until 2012, Sandy Hook Elementary School, that active shooter situation incident that took place over there, that there was a directive that came down through our county, basically saying that every single station out of our entire county needed to go ahead and have not just active shooter response awareness, but they had to go through physical training exercises at the local elementary schools. Just blank it, straight across. And anything like that happens within the incident that goes on. So, the moment that kicked off, we’re in 2017, so for that past 5 years… and, a little bit less than that, because we hit this hard. Out of our team of 30, our sergeant came in and said, “hey, who do I have as volunteers to be part of a tactical medical response team, in order to respond 24/7 to any large active shooter, bomb blast situation, potential threat, anything that goes on in our entire response area?” And eight of us raised our hands. And right after that incident in 2012, we jumped into every single local agency training that we could get into. State agency training, like with California Highway Patrol. And federal agency training. So, whether we’re taking training through FLETC, TECC, ,TCCC courses or doing care under fire, going in with LA Clear, LA HIDTA, any of the other different multiple agencies or training foundations, that we can get into, we would. So, between local, state, and federal, we were able to get into all sorts of different training. And not necessarily to say, “hey, we’re so cool, because you know, we’ve gone through this.” Our team is a very humble team that we’ve got, that can respond anywhere, whether it’d be by ground or by copter. But basically, we took the best practices from all of those different training that are out there. And we saw what worked, we’ve been training down with the military down in San Diego, down on the border for the Border Patrol Agents, Special Operations Unit. and we were able to get the best practices and really bring them back as far as our team, and then actually train our entire station. And now, several of us on our team are academy instructors and in-service instructors for our department, so we can go to any station, and we do, in order to train fellow deputies, throughout their full-time deputies. I’m a reserve deputy, so I have flexibility in my schedule to go ahead and do that. That’s been pretty much the bread and butter in that context of it.

Now, in the High-Speed Tac Med world, I not only get to do the law enforcement type of training, but I also get to jump hands-on into EMT response, Emergency Medical Services Training. And fire department training as well, as far as like, rescue task force. We have a fantastic relationship with LA City and LA County’s fire, and we’ve been able to hop into their best practices, direct us on rescue task force formation, movement, communication, setup when warm zone is declared and everything like that. And one thing that I’ve done in my business and I’ve kind of done this based out of the huge, huge demand that’s out there for law enforcement and fire department and EMS, in order to be trained tip of the sword on what works and what doesn’t work, that is to train in live environment. So, one thing, a High-Speed Tac Med that we’ve been able to do, is we’ve gone to probably over 50… no, more than that. Probably over 75 different live environments, for the past several years. And when I say live environment, I mean elementary schools, junior highs, high schools, universities, movie theatres, corporate offices, churches. We’ve been able to go to malls, airports; everything. Everything, instead of going to some shooting range, that’s out in the… you know, out at a designated location, or maybe like a training center that’s a specifically designed training location. We actually go to the live environment and we practice there with the full-time patrol deputies or officers whoever will respond. We also bring in other officers, like, from higher patrol who potentially respond, national parks or state parks, MRCA. Also, special agents. If they happen to be doing a surveillance, in context, in certain areas that we train at, we’ll pull in DEA or Secret Service if they have protective detail local, or if it affects them. And we’ll actually train with all of them in these live locations.

The way we’re able to do it is simply these excellent relationships that we have; so, just building the network that way. But also, at the live locations, we only go red gun. And we do it super low-profile. So, when we’re in there, it’s normally on the off-business hours. So, if it’s a normal 8 to 5 corporate office, we’ll be there from 8p.m. to midnight. And then we do a four-hour block of training, we’re done by midnight, and then we cut out, put everything back to the way it was, and nobody knows that we were there. Except for, of course, the manager, the facilities manager, etc., the point of contact that we’ve got there. Same thing with movie theatres. Instead of going there whenever things might be going with customers, we’ll go at 6 in the morning, we’ll be done by 10 a.m. So, when the first employee comes in… first additional employee comes in. And so on, and so forth. And just recently, and this kind of relates to how we got into this, we conducted our probably third large-scale active shooter response exercise at a local airport, at Burbank airport. And the fire chief, the police chief for Burbank airport are some of the best that are out there. And they allowed their crews to literally push as hard as they can to stop the threat and to treat the people.

Not only are they well-versed with their trained staff, but they have on their tactics how to pursue a suspect or suspects, in coordinated efforts at the airport. But they also have actually purchased Tac Med Kits, and we train with those, hands-on. Like, full-on taking everything out of the wrapper and train full-on with anywhere from 20, 30, 45 victims, role-player victims that we have, in live locations. Whether it’s their gates, their terminals, ticketing areas, loading zones, we go everywhere. Whether it’s the private hangers, office sections, anything; in order to make sure that their police force can respond as fast as possible. And the fire department, on that context, they respond in a very aggressive way too, in waiting for the protocol warm zone to be announced, but then being able to come in as a rescue task force. Four firefighters with anywhere between two and four law enforcement as force protection to go in, and actually stabilize patients in place.

One of the things that we do that’s a lot different than a lot of the protocols that might be out there, it’s our exercises only go 10 minutes long. And for everybody I’ve ever talked to, it’s kind of an anomaly. They go: why 10 minutes long? The last exercise we did with a large PD in the Los Angeles area was 45 minutes long. Purely, it’s because of this. And we kind of learned this over the way. Is that somebody will go ahead, if they have mass arterial bleeding, if they’re shot in the arm or the leg. Let’s say they’re shot in the arm. They have about… and it hits their brachial artery, where they have mass arterial uncontrolled bleeding. They’ll have about… plus and minus, about 8 minutes before they bleed out. And let’s say they’re shot in their leg, femarl artery. They’ll have about plus minus 4 minutes until they bleed out. So, from that context right there, as far as the fast bleed out, and what we know is just basic first aid. So, from the firefighter side of it, the EMT side of it, I mean, just from the Cop side of it. Just basic first aid. If somebody’s gonna bleed out in about four minutes if they get shot in the leg, mass arterial bleeding, or eight minutes, our exercises should not go beyond 10 minutes, because our capability and our ability to respond as law enforcement, deputies, officers, agents, should literally be able to get the bad guy, get the suspect or suspects in under that amount of time and to treat the people in place, using tourniquets, chest seals, trauma dressing. At the very bare minimum. So, we figured that out and one of the context that now we’re integrated in every single training that we have. It’s 10-minute exercises, two minute debriefs, three-minute resets. And then we go again. So, if we have a four-hour window of training with a SWAT team or a four-hour window of training with patrol shift, or SRT. Or it might just be normal patrol rangers, agents, whoever might be. 10-minute exercises the entire time. So, we’ve kind of developed that secret sauce, and we definitely see the value in what it is, and a lot of people see the value.

That’s why we’ve been incredibly busy. Right after Sandy Hook, and in every single incident that occurred thereafter for active shooter incidents, bomb blasts, vehicle into crowd incidents, we get phone calls, emails, and everything like that, saying: hey, I need training for my law-enforcement agency, for my fire agency, for my civilian employees, that I have in my corporate office. Can you come in here and just give us one hour of run, hide, fight, treat training in here and what we should do, and you’re only given an hour? Can you do it? And we do. So, that’s where it’s kind of gone to. Our overhead staff, we’ve got about 5 core overhead staff that run everything from our top-level operations to our logistics setup. Our planning, our detailed planning, and what would be considered event action plans and ops plans, as far as different agencies and how they have it. We cover everything, from notifications to total number of people and total observers, who they might have for VIP observers. Total number of participants going through, we have our scenario plans on the exact number of times that law enforcement, or fire department, or EMS will be going through the exercises. And we make sure, that by end of what we do, that people not only have the proficiency by a lot of practice, but they’ve got the confidence to go ahead and put a tourniquet on somebody perfectly and effectively, in order to save someone’s life. Or to put on a chest seal, or to put on trauma dressing, or to use QuikClot or a clotting agent if they have to, to save someone’s life. And each one of those tools, no more than 30 seconds as well. I mean, we really push… everything is by time. The way that we go ahead and do it. So, that is pretty much from where it started and why I started the company, just because the demand was so high, and we couldn’t be at all places all the time, and have it expanded out. That’s what we’ve done. That’s what we’ve done over the years.

[TODD DEVOE] That’s outstanding. So, a couple of things that you said that kind of touched home here. And one is, is that obviously, we’re training DHS, FEMA, and also local sheriff’s departments, are really pushing the run, hide, fight scenario for our civilians and for people in offices, in schools, and whatnot. And then you added the treat component to it. And then the other thing that you said, and that’s what I’m really trying to make a paradigm shift on here, is we talk about active shooter a lot. And I think that we should not just picture ourselves into the active shooter, but to the act of violence person, such as, like you said, somebody who’s running into a crowd with a car, or like in Ohio state, where the guy comes out with a sword and starts whacking at people. So, do you guys… talk about your run, hide, and then fight and treat. How that works, and how you get that into the hands of the lay person. And then what are you thinking about as far as the act of violence type-thing, outside of just the active shooter?

[ERIK FRANCO] As a matter of fact, everybody, when we train a run, hide, fight, treat session, we call it an active shooter response info session. That’s one of the big things that we do, and we make it just very, very simple, within one hour, we show the department of homeland security video, as far as run, hide, fight. But what I do is, after that short, about 5-minute video, I actually break it down into the run. Like, what does that really mean? Like, the moment that a vehicle starts coming at the third street promenade, let’s say, when the tolls are taken out and a vehicle just comes straight down, boom! You have to immediately think: first option, it’s gonna be the run that I’m gonna do. I also teach people, before going into the next component, I teach them to think outside the box on the run. If we happen to be at a shopping mall and you hear a gunfire down one main corridor, down forward of you. And all of a sudden you run the opposite direction, but boom! A bomb goes off right behind you. Where do you go? And I teach people, “hey, if you go through any retail store in a shopping mall, like an indoor shopping mall, once you go through the retail store, all the way to the back, past the inventory, push those double doors open. And it goes into a secret hallway. After you go into that secret hallway, push the next doors open, and that will put you on to the parking lot. That’s just an example, as far as being able to think outside the box wherever you’re at.

Just recently, being at several different airports, every… Burbank is an example, or LAX is an example. Every, I don’t know, 50 yards you walk through an airport, you are going to see… and not an exact measurement, but you will see a gathering of different emergency exits that are right there, that you can just go and push through and be out. You have to think outside the box. Anywhere that you can go, the same thing has to do with public venues and hotels, is the run. You have to run. A lot of people ask me, “Hey, how far is far enough away?” And I learned something in my experience of also being a reserve firefighter for about four years, we had what’s called the rule of thumb, that if we had, for example, a tanker that was on fire, or it was going to bleve type-thing, like an explosion, and we wanted to get away, it’s a rule of thumb, where you stick out your thumb, and if you can cover up that building, that tanker, whatever that is that you’re running from, or you’re getting away from, if you can cover up the whole thing with your thumb, that’s about far enough away, right there. Now, in an active shooter component, where there’s bullets flying, that’s where you have to get away as far as you can, then to the point where you’ve got cover. Something that can go ahead and protect you from any random bullets that are coming from that hostile position you’re away. That’s incredibly key and incredibly important. As we know, because of different types of guns and different types of bullets out there, that things can go very far very quick. So, you want to make sure to have that cover as well. That’s the run component, and that’s how I teach it. The hide, I just don’t talk about hide, I actually talk about fortify. So, I jump into the run, hide, fight, treat component, and the hide is fortify. Out of an entire city hall, I teach at a lot of different city halls, all around southern California. And I teach their employees: hey, if something was to happen and you could not run, your next option is to hide. Now, not just any room. And we’re not talking about, just like, hide underneath the table that only has four legs and the bad guy can see you. This is full-on… you have a pre-designated room as far as knowing exactly where to hide, and you’ve practiced. The muscle memory of practicing on your run, your hide, the fight tools that you grab, the treat, as far as being able to throw on that tourniquet, etc., you have to have the muscle memory. So I teach people in the hide, go to that one safe room, or two safe rooms that you have right there. Everybody hustle, and they gotta get there. In time drill exercises I’ve done, Todd, it’s taken in a corporate environment. So, let’s take people who are not trained in emergency services and how fast they can do this. They can get to a hide room at about 8 seconds. No kidding. From sitting in, like a surrounding area, if they have a designated safe room, that they can get into, lock the door, push a copier in front of that door, shut off the lights, everybody turns their phone to vibrate real quick and turns off the alarm components that they have, and they hunkers down, they can do all that in about 8 seconds. And it blows people’s minds. They normally think: “oh no, I couldn’t do that, cause that sounds complicated.” The only complicated thing about anything in response is actually not doing it, it sounds complicated. Once you do it, you’re like: wow, that was actually pretty easy.

[TODD DEVOE] Right.

[ERIK FRANCO] And even from the tactical environment, as you and I both know, the moment you do it, you’re like: wow, that was actually easier than I thought, we talked about it way too much. We should have just practiced it 50 times and we would have been great. So that’s the hide component. To go ahead and fortify doors. I also teach, for example, in schools, classrooms, the easiest way to go ahead and fortify a door, not only, you know, with the lock. In some schools they actually have a push bar, or a lock block that goes on the doors, they add that extra measure. But let’s say you don’t have any of that. When I teach in different schools that don’t even have a lock on their door, I mean, they’re a very open environment type of thing. Every student picks up one desk, that they sit, at that chair that has it attached, and they put it right in front of the door, and they just stack it, you know, up, about 12 high. And then it’s just so complicated to get through that there’s no way that anybody can easily get through it. And I know from going through breaching training with several different agencies, that for me to breach a door… let’s say, it’s just me by myself, and I don’t have, you know, explosives or breaching tools type-things. For me to get through a door that’s just stacked up with desks and tables, there’s no way I can, in a certain amount of time, that… for example, law enforcement, who will respond, will be there faster than I can breach through any type of stack. That’s the one thing on the hide.

On the fight, I go into it as far as a teamwork aspect. I just got done teaching at a city hall last month, and I taught them, all the audience members, I taught them about: hey, let’s say that we go into that hide room, the safe room that we have. And we’re hiding, we’ve fortified the doors. Now we’re gonna grab our weapons that are there. I mean, full-on letter opener, let’s look at a corporate environment. I’m not saying that we have a taser or a gun. Letter opener, you’ve got the fire extinguisher, you’ve got the stapler, you’ve got that trophy that’s sitting on your desk, or in that area, saying, you know, “congratulations for being here for five or ten years.” And you know, it looks like a star type of thing that you can put in your hand. You’ve got all these different things you can use as fight tools, but as far as where to hit any bad guy, it’s very simple. Especially if the bad guy has, let’s say, you know, a vest on type-thing, and they’ve got some arm plates in there, whatever might be. In the eyes, the nose, and the throat. Those are the three things that no matter how much weight somebody bench presses, or how much weight people lift, they cannot build up muscle in their eyes, their nose, and their throat. That’s the way to go ahead as far as hitting right in the computer box to get them disoriented enough to where you can have the advantage. Now, that’s not where it stops. On the fight, I also go into it where people are gonna go over exactly what they’re gonna take in a split-second. So, a leader, and anybody could be a leader in a room. If there’s five people there, you just basically say, “left arm, right arm, shoulders, hips, and legs.” And you do it again. “You’re gonna grab the right arm, you’re gonna grab the left arm, you’re gonna grab the shoulders, you’re gonna grab the hips, you’re gonna grab the leg.” If this bad guy comes in and you’ve got those fight tools, boom! Disorient him, grab that component, and you’re going straight down, and you’re gonna dogpile on top of the suspect, on top of this bad guy. And you’re gonna stay there until the good guys come. Even if the bad guy goes, “Hey, I can’t breathe, get off me.” No, we’re full-on on top. That’s what I teach everybody who’s out there.

Even on the civilian side, within law enforcement stations, that’s exactly what I teach everybody in the secretariats, everybody who’s in our prognosis divisions, at the front desk record. Hey, if you had to hop on somebody, right arm, left arm, shoulders, hips, and legs. And you’re gonna team work it, as far as unit. And you have the lionhearts mentality. The last component, as far as treat, and this is the first slide in my presentations, whenever I’m giving trainings, and hands-on trainings about this, I have a data slide that’s up there, every single active shooter event, every single vehicle-borne attack that’s out there, every single mass knifing that’s out there, a bomb blast that goes off; you have multiple victims who are out there, and you have multiple people dead. Pulse nightclub, Las Vegas. You’ve got this recent one in Texas. No matter where it is, Brussels airport, Paris, you’ve got Mumbai, you’ve got all sorts of different ones. The one thing is not the incident. So, I don’t look at the incident per say, very closely. But I actually studied, and our medical officer on our team studies this too. It’s the number of people – not injured – but the number of people killed. And we look at that based on: did they bleed out? Were they shot in an extremity, mass arterial uncontrolled bleeding? Were they shot on the chest? Did they almost have a tension pneumothorax? Did they die from an airway obstruction? Did they get shot in the mouth, or throat, you know, whatever it might be. So, we look at it from kind of like a biological point of view. If all of a sudden, what caused them to die. If it was a bleed-out, what can we do? One of the things that is very interesting, and if you take a look on the internet, you’ll see this as far as preventable combat deaths. If you just go ahead and type that. And also, if you type it on the civilian side, it means more towards torso shots on different things, which mean more potential for sucking chest wounds and things like that, as far as your ability to treat. But if you take a look at preventable combat deaths, just as an example, 60% of the preventable deaths that are out there on the combat side are mass arterial bleeding.

[TODD DEVOE] Right.

[ERIK FRANCO] 60%. An extremity wound. I think it’s about 33% are from a tension pneumothorax. So, it’s a larger caliber round that goes straight through the bullet resistant protection that somebody’s got. And all of a sudden, tension pneumothorax, the lung starts to go ahead and go up, sucking chest wound, the trachea starts to deviate off to one side, and you’ve got someone who suffocated that way. If you can go ahead and have a chest seal, or you could have a tourniquet. And in those two situations, you would save about 93% of those preventable deaths. If you look at it just like that, for that type of data. Now, and just taking a look at more the civilian side of it, knowing that more gunshot wounds go into as far as hitting lungs, you just need more chest seals. That’s all it is. As far as being able to go ahead and cut somebody’s shirt off, clam shell their shirt open, wipe away any blood that’s there, peel and stick, like a Hyfin vent chest seal, straight on the front. Peel and stick another one on the back, for that through and through gunshot wound. Whether it’s a knife wound, whether it’s a gunshot wound, just that construction site accident, where somebody falls onto rebar and pulls himself off. All of a sudden, they’ve got a second chest wound and a hole right there. You’ve got Hyfin chest heal, boom, you can put one on the front, on the back, on their bare skin. I mean, it’s easy stuff. So, I start that way, and I teach backwards as far as the reason why people die in a short period of time. Then I go into the treat element of it, because one thing people don’t understand is that what hits the news is not necessarily, “oh, 17 people, their lives were saved.” It’s more what hits the top-level banners, 28 people died, you know, 42 injured type-thing.

[TODD DEVOE] Right.

[ERIK FRANCO] But 28 people died, and could we have saved their lives? And the resounding answer is yes. We could have saved their life, which is not a problem at all. If we had a tourniquet, chest seal, and trauma dressing as our option to go ahead and help save their lives. So, on the treat side of it, then I really go into tourniquets. The different types of tourniquets that are out there, specifically SOFTT-W. I also talk about CAT tourniquets, cause those are… there’s a lot of them out there too. Some of the cutting-edge ones, that by far, are the fastest that between law enforcement and civilian clients that I have, are the fastest, which are the M2 ratchet tourniquet. The basic concept of, like the snowboard bindings, or buckles that you have on ski boots or ratchet that you have. It’s a basic concept. On average, Todd, the amount of seconds to put on those three tourniquets, an m2 ratchet, SOFTT-W, and a CAT tourniquet, it’s literally 7 seconds for the m2 ratchet. It takes about 14 seconds on average for a SOFTT-W, to put on. And it takes more, it takes about 23 seconds to go ahead and put a CAT tourniquet. And those stats that I have is from doing, I think, about 42 large-scale exercises. Large-scale being anywhere from 100 to 250 different first responders from law enforcement, EMS, fire, by doing several repetitions, within a two-hour period, four exercises per hour. So, 8 to 12 exercises through, but with multiple people. And I get all that data back, and that’s about the average it takes. Again, with the fastest being m2 ratchet. 7 seconds. And that’s everything from knowing exactly where it is, I gotta put on the leg, high and tight, pull the strap down, ratchet it up, write the time, and I’m on to my next patient. With that type of mentality.

[TODD DEVOE] Has that ratchet device, has it been approved by EMS?

[ERIK FRANCO] Erik Franco on the Paradigm Shift of Active Shooter Response from HSTMHere’s the interesting part about it. On a lot of EMS guidelines that are out there, it talks about a windlass. It talks about, you need to go ahead and have the mechanical advantages as far as having a windlass and turn it so many times so that you stop mass arterial bleeding. Go ahead and hook it into a stop contraction, which could be a delta, or it could be a hook, like on a CAT tourniquet. For some EMS agencies, they need to actually now expand their acceptance of having a ratchet tourniquet that’s on there, because of how effective and fast it is.

I have learned that there are very progressive units that are out there within different agencies, that they get the approval to have the m2 ratchets, and they go back to their medical director, and their medical policy, and say: hey, just add in the m2 ratchet. So you need to go ahead and, here’s a doc of what it is, exact applications, further manufacturer’s guidelines, ratchet it all the way until the bleeding stops, write the time. I mean, it’s about that fast. But things are changing as we speak. Because all the way from Long Beach to Ventura County, to Santa Barbara County, down to San Diego. When I do these trainings, they are like: wait a minute, that was way incredibly fast, on that m2 ratchet. As opposed to these 150 SOFTT-W’s that we have, or these 200 CAT tourniquets we have. You know, things like that. And they make the change. I know that progressive agencies too, with the Burbank airport as an example, they actually update their policy right there to say: ok, we now can use x, y, z, as far as this component, and the EMS element of their training.

To your question too, police officers’ standards and training for the state of California, just this last April, came up with the new curriculum that they have. But if I back up to January, American Heart Association, American Red Cross; all of the instructors that are out there, came into play, and this was even before then, but they were really turning the gauntlet down, and saying: hey, you need to teach everybody on just basic first-aid, whether you’re cop or you’re a civilian, on how to use a combat tourniquet. So that was actually written in there. A chest seal, trauma dressing, QuikClot, or a clotting agent. Not naming QuikClot the brand, but a clotting agent. So, because that came out, it made our training so much easier, because we’ve been teaching that for several years, but now it’s become a requirement, because we know doctors, and nurses, and medical directors, and everybody who directs on what police, fire, and EMS should do, know that these tools, you can apply them in 30 seconds in a mass casualty situation and save multiple lives. So, it’s really kind of come a long way. The hands-on component, when I was talking about treat, for the run, hide, fight, treat component, the hands-on that I do, I actually force every single participant that comes to the training that we do, to put on tourniquets so many times that they can’t get it wrong. I mean, there’s one saying that I’ve heard in, for example, a small arms training that I’ve done, and rifle training that I’ve done, that you don’t want to practice until you get it right and then you stop; you actually want to practice until you can’t get it wrong. And I am 100% behind that, and I’m a firm believer in that. When I first heard that, I’m like: oh, that’s pretty interesting, kind of catchy, whatever it might be. But I’ve actually learned that instead of complicating our training, we make it… see one, do one, and teach one. We do it with repetitions, where people can close their eyes and they can still do the same as far as proper application and exactly of their Tac Med skills. And that’s one thing, which is the walkaway on the treat. On average, out of our 10-minute exercises, it takes, on average, about a minute… let’s say a minute 40 seconds for law enforcement to stop the threat. Which is their number one mission, whether it’s one bad guy, two bad guys. About a minute and 40 seconds.

Then we got it pushed all the way to where it takes probably an average of about 5 minutes and 30 seconds for them to… law enforcement, this is just law enforcement that we train; to have stabilized everybody, have treated everybody in our scenarios. And I’ll give you an example, Todd, the way that I do this, I actually push people to almost their edge on being able to treat victims. If there’s 8 responding law enforcement officers coming in, or agents, or deputies, whoever it might be. They’re broken into two different teams, two teams, four-person contact team, that’s team one, a four-person contact team is team two. Team one will go in, and about 60 seconds later, team two will go into the scenario, to stop the threat and to treat the people. A minute 40 seconds is, on average, the amount of time it takes that one contact team, and the help, a minute later, from the secondary contact team to stop the threat. So, they’re using good tactics, but the time clock for everybody that we have, as far as role players, has started depending on their injury. So, if all of a sudden, they have mass external bleeding out of his leg and the guy comes through with their blank gun and they shoot past a certain point, they start their time clock on the countdown. If all of a sudden, they have mass internal bleeding at their arm, they start the time clock on the countdown. And they have a certain amount of time that, the moment passes and they’re dead. And we have a very accurate tracking of that, because we have the help of our role player’s, countdown timers and supervision that goes on right there with several proctors that we have in strategic positions. That’s how we’re able to get law enforcement to have those fast numbers, is that they practice. But I gotta guarantee, I gotta tell you one thing that’s guaranteed every time. The first exercise we ever do with a brand-new law enforcement agency, no matter if you’re state, federal, or local, everybody normally dies. In our scenarios, in our ten-minute scenarios. They almost always normally die. The reason is because the tactics, and this is kind of the training we get in academies and in in-service training. The tactics, we have them, but a lot of times it’s kind of slow and methodical. And the idea of being a contact team and pushing hard towards the threat is a newer concept that is now becoming old hat. But at the same time, sometimes, sometimes law enforcement agencies kind of pump the breaks real quick when it comes down to treating people, because they might not have a Tac Med Kit on their thigh, they might not have a Tac Med Kit that’s just dropped in the middle of the mass casualty scenes, that they can pull resource out of. Because people are going to bleed out in four minutes, eight minutes, or suffocate within twelve from a tension pneumo, this is one thing that I’ve actually trained cops of how exactly to respond and treat people where they’re at. Now, on the treat element, if I jump into the fire side, as far as training that we’ve done, I’ve done a lot of work with rescue task forces, with training fire departments, that when they put in four firefighters, like a captain, engineer, and two firefighters that are protected by up to two or four law enforcement and force protection and they go into a “warm zone” to treat people, that instead of treating one person and then stabilizing that one victim out of, let’s say, 25; putting that one person on a mega mover, like, on a tac stretcher to bring them out to triage, or bring them out to casualty collection point, I tell them to stop. Not to do that. I actually tell them: hey, as you go through, you’re gonna do it in a very different way. I want you to go through and use your tourniquet, chest seals and trauma dressing on every single person, all 25 role-player victims that we have here, exactly where they lay. And tell them to stay right there. Boom! And you treat them in under 30 seconds, and you’re on to the next, on to the next. And not as a big conglomerate group, too. I have to where rescue task forces actually grow in size as far as their area of responsibility, and the firefighters go out there and they go hands-on, while force protection, while the cops are there protecting them 100% in case there’s a secondary suspect who pops in or comes around or whatever it might be. That has probably been like, the paradigm shift also, as far as just staging out, or when they get the green light to go in, thus is designated as a “warm zone”, that they don’t just stop at one victim, patch them up, and mega mover them out, and then by the time they come back, everybody has passed away, unfortunately, because of mass arterial bleeding, or suffocation, or whatever it might be. Because a lot of times, it takes more than, let’s say, about 8 minutes to get back on a round-trip, taking someone else. So, that’s kind of the different approach I have on treat, and that’s just statistically been the way to go ahead and save as many lives as possible in the shortest amount of time. So, I hope that answers your initial question there, Todd.

[TODD DEVOE] So Erik, do you use the principles of start triage in your training, or do you have a different system that you’re teaching?

[ERIK FRANCO] So, as far as… in the trainings, as far as rescue task force, because on the law enforcement side, they just go in, stop the threat, and treat the people. On the fire department side, I actually have it to where, instead of using like, start where you stand, if you can hear my voice, please, come this way. The way I set up my scenarios, every single scenario is set up to where those people who could run, those people who could walk, those people who could limp out, have actually already run, walked, or limped out of that danger zone. And what you have left over are the people who were shot in the arm, the leg, or the chest that do not have the energy to go out. These are the people that are going to die in four, or eight minutes, or twelve minutes, and you gotta treat them in place. So, that’s what we do on that context. In other types of trainings, though, that I’ve done, where it’s more geared towards, let’s say, a mass casualty situation of a train wreck, kind of like the Chatsworth train wreck that our team had responded to, and doing triage, and all the different… the red, the yellow, and the green tarps, going through that triage process and transport on ambulances, helicopters, and so. That’s a different training that we do, as far as to start triage, and then how fast people can get the tourniquets set up, how fast you can get your transportation crew up, how fast you can get the coordination there, and the people being treated and checked out on ambulances and on the way to the hospitals. But on the active shooter side of it, I actually expedited it to where when they get together as a rescue task force, their whole mission, when they go in, boom! They see somebody down, they expand that huge rescue task force of eight people that are right there, expand it out, treat everybody in that vicinity in less than 30 seconds. Now, if you think about it, you’ve got, let’s say, four firefighters that can go hands-on and treat somebody with a single wound, let’s say, single life-threatening wound, but they can treat them in 30 seconds. And if they can, now you’ve treated four people in 30 seconds. You go up a little bit, another four people in 30 seconds. You go up a little bit, another four people in 30 seconds. And that, just statistically, just by the numbers, saves the most amount of people.

I have tried, where we go in: hey, if you can hear my voice, go this way, and go straight out that exit, go to the right, and just stay there, there’s gonna be more people to get you. What happens is, those people have mass arterial uncontrolled bleeding out of their arm, let’s say. They basically die in a different location than where they were initially found, in the context of it being a warm zone, that’s still chaotic and developing. In that 10-minute time clock that you’ve got. Also, as far as going around and doing 30-2-can do, on their RPM, for example, when you’re taking the respiration count, and you’ve got perfusion as far as cap refill, and then you’re asking them if they can do this, and that, and the other, and just check if they’re in a consciousness and with it or have an alternate level of consciousness. Going through all that, it just takes too much time, in the context of 30-minute hands-on lifesaving treatment, and then boom, on to the next. With the force multiplier of four hands-on in 30 seconds, and boom, move on to another. Four people, hands-on, and so on and so forth. The one thing too, I’ve also taught in conjunction, is when let’s say you have four contact teams that are in, going after this bad guy. The moment that the threat has been stopped, neutralized, secured, and the weapon is secured, all of those contact teams, minus one officer, agent, deputy, whoever it might be, who has to stay with the down suspect; all of those contact team personnel can now switch into… and they do this quick in their minds. A rescue team. In the context of, my Tac Med Kit I have on my thigh right here, that Tac Med Kit has two tourniquets, two chest seals, two trauma dressings, and some medical shears and some gloves. I am going to treat as many people as I physically can possibly do, with what’s in my kit. The moment I exhaust all of my resources in my kit, and I’ve treated four critical, then I’m gonna start asking for tourniquets. “Hey, toss me a tourniquet. Toss me a chest seal, toss me the trauma dressing,” whatever I can do that way. And what’s funny is, you would think, you know, cops are not accustom to that. The moment you put them through twelve times on this operation, they get it. And man, they’re quarterbacking everything, like, “Hey, toss me this.” Wide receivers, all sort of stuff coming in. Some agencies, I’m actually very proud to say, some agencies have gotten with the program, and they purchased a mass casualty kit that’s got 50 tourniquets, 50 twin patch chest seals, and 50 trauma dressings with medical shears and gloves. Just that, just that. No band-aids, no Neosporin, no ice packs and stuff. None of that, just those critical life-saving items in a kit, in like an art kit, or some sort of mass casualty kit that they just drop straight into the problem. And these cops rip it open, and then boom! They dig out of that as their resource hub to go hands-on. Because the rescue task force, it still takes them a movement to go. Even four at a time, 30 seconds, hey, that’s cool. That’s how many lives are being saved. But if you have 50, you need as many cops who are not on the bad guy, so to speak, after the threat has been stopped, who can treat as many people as possible. So, we teach in a very expedited fashion, and it’s all based on time, all based on number of casualties, and all based on the outcome of being, all the people died on the first exercise, all the people lived in the last one. And the only thing that changed was repetition, familiarity, and the concept click that we have to stop the threat as fast as we can and treat all the people. And I mean, everybody goes hands-on, throwing the tourniquet on some victim who’s got mass arterial bleeding or sucking chest wounds, or whatever might be that way. Because that’s just the basic level of first-aid, so…

[TODD DEVOE] Right.

[ERIK FRANCO] There you go.

[TODD DEVOE] I know that you got another appointment coming up here, we’re coming close to the end, so, if someone is really interested in getting your training, how could they get a hold of you?

[ERIK FRANCO] Basically, there’s a couple of different… three. Three key ways that we have as far as any training that anybody wants to get. First and foremost, the simplest way is that they just go ahead and drop us an email, at training@highspeedtacmed.com. So, it’s training@highspeedtacmed.com that’s one way. Another way is, if they just call our office. We got it to where any type of training, anybody needs, whether it’s law enforcement, corporate, the private sector, executive protection, anybody who needs help and training, they can either drop us an email or they can give us a call. And the phone number is 805-419-0024. So, 805-419-0024. The last way that somebody can get a hold of us too is to go to our website, the www.highspeedtacmed.com. And they click on the contact section. Inside, there’s this little form they can fill out, hit send. Immediately, it comes into our team. And it could be a plethora of things. Because I’ve got different specialists within the company that teaches everything from emergency response to medical response to security response, disaster recovery, business continuity, tactical medicine, active shooter response, bomb blast response. I mean, we’ve got a plethora of different specialists that we have within our company, that are able to teach several different courses. But those are the three top ways right there.

[TODD DEVOE] For those of you who are listening on the road and don’t have your pen and paper ready to go, we will have this information on our show notes as well, so don’t fret. You will be able to get this information. All right, Erik, here is the last question, it’s the toughest one of the day. So, somebody who is just getting involved in this business, what book would you give them to say, “Ok, this is how you’re gonna get information and be ready to roll”?

[ERIK FRANCO] So, one of the things that I’ve really grown to respect, I’m extremely humble when it comes to learning from other people, you included. And several people that we know mutually, I mean, out there in a small world. I really respect mindset. The mindset and the mind practice that a lot of people have. And what I call the lionheart, as far as their ability to go ahead and respond. A really good book in order to just know that mindset and what you have to practice and rehearse mentally in your subconscious, and you know, just jump the hurdle, is “The Bulletproof Mind”, by Lieutenant Colonel Grossman. That is something that just teaches you that perspective of your mindset, of whether you are the people who is going to lead, follow, or kind of get out of the way, you’ll get it right there. And also, that things are not as complicated as you think. If you have just that awareness, you have that capability in your mind that you can do absolutely anything! Anybody can. That’s just one reiteration, right down that build of confidence, but build on reality, that anybody can do whatever they literally have practiced their mind to. Not just put their mind to, but practiced it through. So yeah, “The Bulletproof Mind”, by Lieutenant Colonel Grossman is one of several people that wherever he speaks, whatever material he has, anything that goes out, fantastic. Along with several others, but I would say that would be one really good buy.

[TODD DEVOE] I just wanna say thank you so much for being here on the show, and is there anything else that you’d like to say before you gotta go?

[ERIK FRANCO] You know, no. I appreciate, literally, the time that you’ve given me to go ahead and share with you and listeners as far as what the reality on Tac Med responses that’s out there. Here’s the biggest thing, as far as the key takeaway that I have for people. Is that the run, hide, fight, treat. Those four things there, and anybody from civilian all the way to law enforcement, to fire to EMT. Just anybody who is a citizen, a human that’s here. Knowing how to master those four key components right there will not only save their life, but their loved ones’ lives, their co-workers’ lives, their family members’ lives, a stranger’s life, whoever might be. Knowing how to go ahead and do that is key and critical. The last component there, on the treat, a lot of people go: Erik, I’ve never taken a tourniquet, chest seal trauma dressing to the beach with me. What do you do if you’re at the beach? What do you do if you’re in a concert? What do you do if you’re in a movie theatre? What do you do if you’re at church? And what I tell them is, saying, hey, if you’re on my training today, what you need to do is get a $30 tourniquet, you need to get a $6 trauma dressing, and an $18 twin pack chest seal, like the Hyfin chest seal. And throw that into a plastic bag, throw it at the bottom of your purse, bottom of your briefcase, in your bag, your backpack, whatever it is that’s with you. And now, you’ve got those tools there that can save someone’s life in less than 30 seconds. So, that’s the biggest takeaway right there. Just don’t listen to the material and go: hey, those are good points. Those three things, in total, I mean, in total, it costs less than like, $60, and it can save someone’s life in less than 30 seconds, and yours or a loved one. I mean, that’s the key takeaway right there.

[TODD DEVOE] All right, brother, thank you so much.

[ERIK FRANCO] You got it, Todd. Thank you again, I appreciate it.

Links

http://www.highspeedtacmed.com

training@highspeedtacmed.com

805-419-0024

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About Todd De Voe 62 Articles
Involved in Emergency Response, Emergency Management, Education and Volunteer Management for over 25 years.Served as a Corpsman assigned to the Fleet Marine Force of the United States Navy. I now teach Emergency Management at Coastline Community College, I am also the Host of EM Weekly.

1 Comment

  1. This was a very informative podcast. I had heard about the run and hide component but not fight and treat. These are all good tips to keep in mind if ever put into this type of situation. I have really enjoyed listening to the different podcasts.

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